routine hiv screening in health care settings
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Routine HIV Screening in Health Care Settings. 2006 CDC HIV Screening Recommendations. David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle. - PowerPoint PPT PresentationTRANSCRIPT
Routine HIV Screening in Health Care Settings
David Spach, MD
Clinical Director
Northwest AIDS Education and Training Center
Professor of Medicine, Division of Infectious Diseases
University of Washington Seattle
This project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC).
2006 CDC HIV
Screening Recommendations
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
2006 CDC HIV Screening RecommendationsOrganizations that Support CDC Recommendations
American Academy of HIV Medicine (AAHIVM)
American College of Obstetrics and Gynecology (ACOG)
American College of Physicians (ACP)
American Medical Association (AMA)
HIV Medicine Association (HIVMA)
National Association of Community Health Centers (NACHC)
National Medical Association (NMA)
Routine Screening for HIV Infection
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• All patients aged 13-64 in all health care settings
(Unless prevalence of undiagnosed HIV < 0.1%)
Routine Screening for HIV Infection
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• All patients aged 13-64 in all health care settings
(Unless prevalence of undiagnosed HIV < 0.1%)
HIV Screening: performing an HIV test for all persons in a defined population
Routine Screening for HIV Infection
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Screen Unless Yield of Screening is Less than
1 Infection per 1000 Patients Tested
• All patients aged 13-64 in all health care settings
(Unless prevalence of undiagnosed HIV < 0.1%)
Source: Wilson JMG, Jungner G. Principles and Practice of Screening for Disease. WHO Public Health Paper.
No.34. 1968.
.
WHO Criteria that Justify Routine Screening for a Medical Test
• Serious health disorder that can be detected before symptoms develop
• Treatment is more beneficial when begun before symptoms develop
• Reliable, inexpensive, acceptable screening test
• Costs of screening are reasonable in relation to anticipated benefits
• Treatment must be accessible
Source: Wilson JMG, Jungner G. Principles and Practice of Screening for Disease. WHO Public Health Paper. No.34. 1968.
Routine Screening for HIV Infection
Source for Images: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
• All patients aged 13-64 in all health care settings
• Patients seeking treatment for STDs
Secondary Syphilis Gram’s Stain Gonorrhea
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Routine Screening for HIV Infection • All patients aged 13-64 in all health care settings
• Patients seeking treatment for STDs
• Patients initiating tuberculosis treatment
Image Source: HIV Web Study (www.HIVwebstudy.org)
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Indications for Repeat HIV Screening
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Injection-Drug Users & their Sex Partners
Persons who Exchange Sex for Money or Drugs
Sex Partners of HIV-Infected Persons
Persons or their Partners with >1 Sex Partner
Since their Most Recent HIV Test
• Persons at high risk
Indications for Repeat HIV Screening
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Persons at high risk
• Persons starting a new sexual relationship
Indications for Repeat HIV Screening
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Persons at high risk
• Persons starting a new sexual relationship
• Clinical judgment
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Consent and Pretest Information
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Voluntary testing
Consent and Pretest Information
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Voluntary testing
• Permission from patient required
Permission Required
Consent and Pretest Information
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Voluntary testing
• Permission from patient required
• Written consent should not be required
Written Consent Should Not be Required
Consent and Pretest Information
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Voluntary testing
• Permission from patient required
• Written consent should not be required
• Prevention counseling not required in conjunction with screening
Prevention Counseling Not Required
in Conjunction with HIV Screening
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Diagnostic Testing for HIV
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Images Source: HIV Web Study (www.HIVwebstudy.org)
• Clinical manifestations of HIV/AIDS
Kaposi’s Sarcoma
Oral Hairy Leukoplakia Pneumocystis pneumonia
Oral Candidiasis
Diagnostic Testing for HIV
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
• Clinical manifestations of HIV/AIDS
• Acute HIV (Recent high risk exposure + illness consistent with acute HIV)
High Risk Exposure
Diagnostic Testing for HIV
Source: Vanhems P, et al. AIDS. 2000;14:375-81.
• Clinical manifestations of HIV/AIDS
• Acute HIV (Recent high risk exposure + illness consistent with acute HIV)
Signs and Symptoms of 160 Patients with Acute HIV
Laboratory Studies with Initial HIV InfectionHigh Level Viremia
HIV RNA levels abruptly rise within several weeks after acute infection
Infection
HIV RNA
Laboratory Studies with Initial HIV InfectionHigh Level Viremia Precedes Detectable Antibodies
Antibody Titer
Infection
HIV RNA Antibody Titer
Detectable Antibody
Laboratory Studies with Initial HIV Infection
“Window Period”
Detectable AntibodyDetectable Antibody
Window Period
Infection
Antibody Titer
HIV
RN
A (c
opie
s/m
l)
Laboratory Studies with Acute HIV
Antibody Titer
Detectable Antibody
Acute HIV
Infection
HIV RNA
• Positive HIV-1 RNA Assay and Negative HIV Antibody Test
Antibody Titer
Detectable Antibody
2006 CDC HIV Screening RecommendationsSummary of Key Recommendations
• Routine Screening for HIV Infection
• Indications for Repeat HIV Screening
• Consent and Pretest Information
• Diagnostic Testing
• Recommendations for Pregnant Women
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Recommendations for HIV Screening in Pregnancy
Source: CDC. MMWR 2006;55(no. RR-14):1-17.
Recommendations
• Universal Opt-Out Screening
• Timing of HIV Testing
• Rapid Testing During Labor
• Address Reasons for Declining Test
• Repeat Test in 3rd Trimester in Certain Circumstances
Resources for HIV Testing in PregnancyCDC: One Test/Two Lives
http://www.cdc.gov/hiv/topics/perinatal/1test2lives/
Resources for HIV Testing in PregnancyACOG: Perinatal HIV Recommendations
http://www.acog.org/departments/dept_notice.cfm?recno=39&bulletin=3527
Resources for HIV Testing in PregnancyNational Clinicians Consultation Center: Perinatal HIV Hotline
http://www.nccc.ucsf.edu/about_nccc/perinatal_hotline/
1-888-448-8765
Acknowledgement
The project was funded under cooperative agreement
number U65/PS000821 from the Centers for Disease
Control and Prevention (CDC).